Manager, Claims & Care Management

JOB SUMMARY: The Manager, Claims & Care Management is responsible for providing leadership and technical direction to the supervisors of the Claims and/or Care Management teams. This includes claimant and provider eligibility determinations; development of claimant care plans and continued reassessment of claimant and provider eligibility.

Essential Functions

Title: Manager, Care Management

FLSA: Exempt

Job Summary
• Provide oversight to supervisors of the Staff including general human resource duties such as hiring new employees and performance management of existing employees.
• Mentor direct reports and position qualifying employees for promotional opportunities.
• Create and maintain process workflows, internal procedures, training curriculums, production metrics and quality review performance measurements at both a team and an individual level.
• Review existing processes and procedures, as well as system design, for effectiveness. When necessary, develop a plan and make the appropriate recommendation for improvement.
• Responsible for ensuring inventory levels and individual caseloads are managed in a timely manner to meet service level requirements.
• Assist staff with questions and problems related to all aspects of benefit eligibility determinations.
• Interact with clients to resolve concerns with internal procedures, process improvements, inventory levels, quality performance and escalated handling of cases.
• Identify and escalate high-visibility issues to the department manager or director, when necessary.
• Attend and facilitate meetings to communicate information necessary to conduct all aspects of business.
• Assist in the on-boarding of new clients, including but not limited to Requirement Analysis Document (RAD) discussions, data conversion, plan building, product testing and defining reporting requirements.
• Coordinate, with other departments within illumifin, an overall effort to secure new business and retain existing business.
• Demonstrate effective communication skills.
• Successfully manage vendor relationships.
• Responsible for department’s profit and loss performance. Review monthly and annual progress against budget plan by identifying opportunities and challenges. Monitors budgets, researches and resolves discrepancies and reports all variances on a monthly basis.
• Understand all aspects of production support issues.
• Be versatile in staffing readiness based on trends of each client.
• Effective communicate all aspects of the business, including Practice Standards, to all clients.
• Performance management at a team level.
• Other duties as assigned.

Essential Functions
• Is accountable to Director of Operations or VP of Operations.
• Has responsibility to interact with direct reports, clients, policyholders, legal representatives and agents.
• Demonstrate ability to prioritize workloads.
• Use time effectively to achieve expected productivity and efficiency.
• Maintain appropriate confidentiality.

Non-Essential Functions
• Maintain knowledge of benefit eligibility provisions of multiple long term care policies and plans.
• Possess extensive knowledge of claims systems, process and procedures.
• Demonstrate understanding of company-wide and department-specific policies and protocols.
• Maintain punctual and consistent attendance.
• Complete other duties as assigned.

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